OBJECTIVES

The HIV antiretroviral therapy (ARV) landscape changes frequently with introduction of new treatments and newly published evidence. The Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines provides recommendations for how to treat newly-initiating patients and updates these guidelines regularly. Provider adoption of new guidelines in the real-world largely is unknown. This study examines the association between DHHS-recommendations and treatment decisions for HIV patients newly initiating ARVs.

METHODS

Patients with HIV-1 newly initiating ARV on a 3-drug regimen were identified from Optum administrative claims database (2008-2016). Continuous enrollment of 180 days prior to and 30 days following initiation was required. Patients with HIV-2 were excluded. A regimen was defined as 1 anchor ARV and 2 backbone ARVs, regardless of booster ARV, within 30 days of initiation. Each guideline period was the release date of the guideline through the day before the next release. The distribution of treatment regimens by guideline period are described by anchor medication, overall regimen, single-tablet regimen (STR), and guideline recommended versus not recommended. Results are stratified by type of insurance, age and gender.

RESULTS

Analyses included 9,249 patients, 85% male and 62% aged 18-44 years at initiation (mean 41±12 years). During 2008-2016, top initial regimens were efavirenz + tenofovir DF (TDF)/emtricitabine (FTC) (36%), elvitegravir/cobicistat/TDF/FTC (12%), and rilpivirine + TDF/FTC (9%). Depending on the guideline period, 50% to 93% initiated on a guideline recommended regimen (72% overall). There was a clear shift from non-nucleoside reverse transcriptase inhibitors and protease inhibitors to integrase-strand transfer inhibitors. A larger percentage of females (32%) and Medicare Advantage enrollees (34%) initiated on non-recommended regimens versus males (27%) and commercial enrollees (27%), respectively. Most patients (67%) initiated on STRs.

CONCLUSIONS

Providers generally follow DHHS guidelines, however, certain segments of the population are prescribed regimens prior to recommendation, and after they are no longer recommended.